No homebirths for women more than 30 minutes from hospitals - HSE

Community Midwives Association chairwoman Ali Murphy says the HSE 'is going to have blood on their hands' if the homebirth service is limited to those living within a half hour of a maternity unit. Picture: PA/thinkstockphotos

A HSE recommendation to limit homebirths to women who live within 30 minutes of a maternity hospital has been criticised for denying one-fifth of pregnant women the option of a home birth. 

Community midwives say the change would have the greatest impact on those living in rural areas.

Midwives are also fearful it will encourage pregnant women to turn to free-birthing — giving birth at home without supervision — which carries health risks for both the mother and the baby.

Community Midwives Association chairwoman Ali Murphy warned that the HSE is “going to have blood on their hands” if the recommendation is implemented.

Governance of the HSE National Home Birth Service is moving from community healthcare to integration within the acute hospital network and midwives say they were told this would not mean changes to the service.

However, in a significant change, the HSE National Women and Infants Health Programme is “recommending that from a clinical perspective it would be safest” that all women accessing the HSE National Home Birth Service would reside 30 minutes or less blue light distance from their nearest maternity service, states a letter seen by the Irish Examiner.

It says this includes ambulance transfer and response times, as well as time until assessment upon arrival at the hospital.

Signed by national clinical director Cliona Murphy and lead midwife Angela Dunne, the letter was sent to Liam Woods, outgoing director of acute operations, in July.

“This is infringing on women’s human rights by installing a 30-minute transfer limit,” said Ali Murphy, reacting to the recommendation.

"That is all fine for Dublin. This does not equate across the rest of the country. We were promised from the beginning that the service would transfer as is, they are not doing that. "

She is concerned limiting access to trained midwives “will push more women towards free-birthing”.

“It is my strong belief that free-birthing is on the rise. The HSE is going to have blood on their hands. Women want choice, they want to be able to birth their babies where they want to birth their babies.”

Community midwife Elke Hasner, who is based in Macroom, Co Cork, described the proposal as “distressing”.

“It does not take the Irish situation into account at all, you have to look beyond the Pale,” said Ms Hasner, referring to Dublin which has three maternity units.

"In my case, it would be more than 80% of my eligible women would be excluded. "

The letter states the recommendation is based on “geospatial analysis of travel-time/distance around acute maternity units”.

It says this projected numbers of child-bearing-age women up to 2040, and found “over 80% of the projected populations reside within an indicative 30-minute blue light travel-time zone”.

A HSE spokeswoman said they cannot comment until the proposal has been discussed by the National Oversight Group for the HSE National Home Birth Service.

“If you assume that it is from phone call into the hospital, that excludes Macroom, Skibbereen, Bandon as far as we interpret it,” said Ms Hasner.

“It is blue-light time they say, and further restricted by conditions. Even if it’s just 30-minute travel time then Clonakilty [and] Ballydehob are all excluded.”

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Spokeswoman for maternity advocacy group Aims Ireland, Krysia Lynch, said that the proposed model would deprive 20% of pregnant women of choice.  

"By today’s figures, that would mean some 14,000-15,000 people being denied a birth choice that features prominently in the National Maternity Strategy," Ms Lynch said. 

The focus on safety follows the tragic death of Laura Liston after a homebirth earlier this year in Limerick, as two separate reviews continue into maternal deaths at hospitals in Cork and Kerry.

Last year, almost 650 women chose homebirth, an increase of 53% on 2019.